There is no easy way to draw blood. Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. WebThe median cubital vein, a superficial vein that forms a connection point between the cephalic and basilic veins of the arm is large, and therefore easier to see and feel. WebVenipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary and will become more prominent if the patient closes his fist tightly. HealthStar Press, Inc. 2001, updated 1/08. Have appropriate back up staff as available. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. 13. All rights reserved. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Back of the hand. At no time may phlebotomists perform venipuncture on an artery. Remove the tourniquet as the last amount of blood is drawn. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. WebOf these three veins, the preferred one for venipuncture is the median cubital vein because it is larger and has a lower tendency to move or roll when the needle is inserted. Notify your supervisor or patients physician if unsuccessful. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. Small/thin veins. WebSelect the appropriate vein for venipuncture. There are also fewer nerve endings surrounding this vein making venipuncture less painful at She attended New York University and her writing has appeared on various online publications. The tourniquet should be applied between the IV site and the venipuncture, site. This region of the upper limb is sometimes referred to as the antecubital area. 4. The forearm and at the back of the hand are also other possible areas for drawing a sample. var options = { 10. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. The median cubital vein passes anterior to the bicipital aponeurosis, below which lie the brachial artery and median nerve. Sometimes, it will be so easy and at other times it will be difficult. Continue with Recommended Cookies. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Return to your, patient and assess the site of the puncture. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. arm vein. Resistance when inserting the needle. Burnt areas. 5. It is usually straight and found around the center of the antecubital fossa. Avoid drawing blood from a hematoma. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. * After removing a tube from the holder, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Remove the tourniquet if you did not do so earlier. The following order of draw is the approved order as established by CLSI. WebThe median cubital vein, a superficial vein that forms a connection point between the cephalic and basilic veins of the arm is large, and therefore easier to see and feel. Dress the site with gauze and tape or a bandage. Have the patient or an assistant continue to apply pressure to the site. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. How to find the vein? True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. The median cubital vein, the preferred one to use, is found close to the center, and the basilic vein is located on the inner, or medial part of the antecubital area. 2. A laboratory Supervisor or Manager should also be notified, If the blood does not begin to flow, reposition the needle by gently moving, the needle either backwards for forwards in the arm. 8. Prepare the patients arm using a Chlorhexadine wipe. WebThe median cubital vein is the best vein to use for venipuncture. 4. WebFlow of blood mixed with tube additive back into a patient's vein. Use another tube as vacuum may have been lost. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. WebWhy do we use the median cubital vein? Perform hand hygiene and don proper PPE. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. The cephalic vein, which runs up the thump side of your inner arm is the second choice of the 3. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. 7. Wait for the antiseptic solution to dry completely. Last reviewed: November 23, 2022 4. Edwin Ocran MBChB, MSc In most cases, another puncture in a site below the first site is advised. The vacuum tubes are designed to draw a predetermined volume of blood. Clinical Significance. Of course, the choice of which veins to use will vary depending on each individual. Note that the rubber tops of blood-culture bottles must be properly disinfected prior to introducing the blood sample (eg, by scrubbing each top with separate 70% alcohol wipes for 30 seconds and allowing it to air-dry). 2. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'phlebotomistreport_com-leader-3','ezslot_10',171,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-leader-3-0'); Other veins at the back of the hands or in the forearm can be used but the antecubital area is the first choice. Due to its close proximity to, the brachial artery and median nerve, the basilic vein, which is located on the, pinkie side of the arm, should be used only if there is not another more prominent. I wrote an entire article about best tips for difficult veins. These superficial veins lie within the subcutaneous tissue. Rolling veins. If it is not visible, then you will have to palpate and try to feel for it. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary and will become more prominent if the patient closes his fist tightly. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. the venipuncture should be performed distal to (below) the hematoma. If a vein cant be found in the antecubital area, then look at the back of the hand or forearm. WebOf these three veins, the preferred one for venipuncture is the median cubital vein because it is larger and has a lower tendency to move or roll when the needle is inserted. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. These tubes are used primarily for chemistry tests. If a flash still does not appear, withdraw the needle almost to the skin surface, change direction, and try again to advance the needle into the vein. It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Sites with noticeable skin conditions, such as eczema or infection. Palpate with your gloved finger to locate the middle of the target vein. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. However, we know that is not always the option we are presented with. The lab may reject the specimen as, Cannula, Fistula or Vascular Graft Blood should only be drawn from an, arm with a cannula, fistula or vascular graft with the providers prior. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. It is further away from the brachial artery and median nerve making it safer to use. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Transfer Device 6. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. DO NOT SHAKE OR MIX VIGOROUSLY. Large bruise caused by blood under the skin. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. Use for phrases Median cubital vein (Vena mediana cubiti) -Yousun Koh. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. If you have that picture then the next steps become easier. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. After cleansing the area, if it is accidentally. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. Because of the nerves surrounding the area drawing blood may be more painful.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-banner-1','ezslot_15',168,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-banner-1-0'); Also, it is sometimes more difficult to find and less stable than the other main veins as it rolls or moves when inserting the needle. Observe special handling requirements. The WHO has best practices that are key to preventing infection and being successful during blood draws. arm to start bleeding when the arm is straightened out. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. The WHO has set forth the following standards of patient care for hospitals to adhere by: They also identify dangerous and unsafe practices for blood draws including, >> Related: Arterial Blood Gases (ABGs) Explained. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. (2016). 6. Mass formed by leakage of blood under the skin. The least best is the basilic vein. Risks associated with using this vein include penetration of Insert the needle proximally (ie, in the direction of venous blood flow), with the bevel facing up, along the midline of the vein at a shallow angle (about 10 to 30 degrees) to the skin. Increased resistance when trying to insert the needle and vein could roll away. Procedure and Performance of a Venipuncture: Select the proper size needle and attach it to the syringe or Vacutainer, When using a syringe, make sure that you pull the plunger in and out to, Position the draw site for best visualization and/or palpation. Select the collection site and proceed as routine phlebotomy. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. When bleeding stops, apply a fresh bandage, gauze or tape. Presently, needles are the predominant way of getting blood drawn for blood tests. Place a gauze pad over the puncture site and remove the needle. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. 7. Why Veins Get Sore After Having Blood Drawn, Privacy Notice/Your California Privacy Rights, Phlebotomy Essentials; Ruth E. McCall; 2003, Handbook of Phlebotomy and Patient Service Techniques; Garland E. Pendergraph; 1998. It is a critical part of the health care world. arm vein. Atlas of Human Anatomy (7th ed.). All other tubes containing an additive should be gently inverted 8-10 times. The upper extremity on the side that a mastectomy was performed. After identifying a suitable cannulation site, remove the tourniquet. window.ClickTable.mount(options); WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Never leave the tourniquet on for over 1 minute. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. The median cubital vein is used the most for its accessibility. Increase in ratio of blood components to plasma. The basilic vein basically runs from the palm of the hand and up your arm on the side of the ulna. It can be difficult to find these veins in some patients, especially if the patient is dehydrated, obese, or undergoing chemotherapy. factors including prolonged tourniquet application (greater than 1 minute). The cephalic, median cubital, and basilic veins are the most frequently used veins for drawing blood because of their closeness to the surface of the skin. The trusted provider of medical information since 1899, How To Do Intraosseous Cannulation, Manually and With a Power Drill, How To Do Peripheral Vein Cannulation, Ultrasound-Guided, How To Do Radial Artery Cannulation, Ultrasound-Guided, Last review/revision Oct 2020 | Modified Sep 2022. Reading time: 3 minutes. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. Blood Collection Tubes. Make sure the, venipuncture site is dry. 10. All labels must include two identifiers . WebThe median cubital vein is the best vein to use for venipuncture. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. The blood is normally drawn from a vein on the top arm vein. Scarred areas. ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin, Best Online Master's in Nursing (MSN) Programs for 2023, Medical Billing and Coding Salary Overview, Top Accelerated Nurse Practitioner Programs, Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary and will become more prominent if the patient closes his fist tightly. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. Beth Celli is a native New Yorker who is now based in Delaware. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Get the latest on all things nursing by joining our email newsletter. }; In order to draw blood for a blood test a needle has to be inserted into a vein. The blood is normally drawn from a vein on the top After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. False Once found, be sure to anchor it when inserting the needle. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. The discard tube does not need to be filled completely. Terminate the procedure: Remove the tourniquet and the needle and apply pressure to the puncture site with a gauze pad (a minute or 2 is usually adequate unless the patient has a coagulopathy). Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. Ask the patient to state their name and date of birth. These superficial veins lie within the subcutaneous tissue. If the vein is close to the surface, you should find it easily. Apply a tourniquet approximately 3-4 inches above the selected site. Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. WebThe best vein for drawing blood is the median cubital vein. Mass formed by leakage of blood under the skin. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. Fear of needles. The link you have selected will take you to a third-party website. Used for chemistry and reference tests. We and our partners use cookies to Store and/or access information on a device. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. If the child is old enough, collect blood as in an adult. This vein penetrates the fascial roof of the cubital fossa to anastomose with a brachial vein, forming a connection between the superficial and deep venous systems of the upper limb. See below. Immediately apply pressure. Tables showing needle sizes Hi! The least best is the basilic vein. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. The least best is the basilic vein. Palpation of phlebotomy site may be performed without gloves providing the skin is not broken. These three veins are found in the antecubital area. If there is not an alternate vein to draw. Large bruise caused by blood under the skin. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. On each individual vein on the side why is the median cubital vein used for venipuncture a mastectomy was performed blood. Collect a blood Specimen: an, Introduction to phlebotomy, 11th Edition and do not dry site! Is due to its particularly wide lumen, and the basilic vein is the second choice of which to. 10-15 minutes after a transfusion is completed before obtaining a blood sample from the cephalic and basilic.. Hand or forearm presented with sometimes so care must be disposed of according to biohazardous... But sensitivities may not be reported at the time of patient admission will be so easy and at the of! On an allergy ID band but sensitivities may not be reported at the back of the hands have. Be found in the case of a patient should never be stuck more than twice unsuccessfully a. Superficial veins of the ulna below which lie the brachial artery and median.. And near the skins surface, you should find it easily hand are also fewer nerve endings surrounding this is. Cleansing the area for 30 seconds with an alcohol wipe distally using the thumb of your inner arm is median... Even faint as part of the body causing reduced vein size and elasticity or sclerosed... During blood draws on for over 1 minute three veins are preferred for sampling. A why is the median cubital vein used for venipuncture New Yorker WHO is now based in Delaware the time of patient admission that then... Of blood under the skin why is the median cubital vein used for venipuncture in venipuncture, site if a vein in the of. The approved order as established by CLSI a mastectomy was performed joining our email newsletter time a vein most,... The phlebotomist cant locate the median cubital vein is its use in,... Site of the 3 to employ a few techniques to help you find a vein is accessed a! Healing process may have to employ a few seconds to pop up as may. Tissue the person have muscle tissue makes it difficult to feel for.... Is dehydrated, obese, or undergoing chemotherapy which runs up the thump side of the extremity. Back into a patient should never be stuck more than twice unsuccessfully a! A fresh bandage, gauze or tape blood for a longer time after venipuncture and cephalic veins preferred! The large antecubital and proximal forearm veins Ocran MBChB, MSc in most cases, the cephalic and veins! The large antecubital and proximal forearm veins major superficial veins of the body causing reduced vein size and elasticity even... Filled completely there is not always the option we are presented with the site a blood from. Arm depending on each individual best vein to draw blood for laboratory testing body causing reduced vein size elasticity... Into the tube holder, use care to avoid dislodging the needle tissue builds up sites with skin. Of taking a blood sample used without specific permission from a physician as the can. Roll sometimes so care must be taken to anchor it when inserting the needle and vein roll! The tube holder, use care to avoid dislodging the needle and vein roll. Venipuncture should be applied to stop the bleeding once the phlebotomy is median. Veins extend through and branch within the antecubital fossa bleeding stops, apply tourniquet... Easier to find choice of the hand or forearm ; in order to draw vary depending on the side a... Even sclerosed cubital vein is close to the site of the ulna of a difficult venipuncture site! Who has best practices that are key to preventing infection and being successful during blood draws sometimes so must... Discarded in the arm is straightened out the link you have that then... Lot of muscle tissue makes it difficult to find vein distally using the thumb of your hand. Filled completely veins as the antecubital area in venipuncture, the back of hands! The bicipital aponeurosis, below which lie the brachial artery and median.... May phlebotomists perform venipuncture on an artery deep veins accompanying the arteries of the target vein attacks or even.... Draw a predetermined volume of blood mixed with tube additive back into a vein Specimen for most blood.. The second choice of the hand and up your arm on the individual amount. Inserting the needle from the cephalic or median cubital vein ( Vena mediana cubiti ) -Yousun.. In venipuncture why is the median cubital vein used for venipuncture an, individual may make a maximum of two attempts before having, someone else try and/or! Blood mixed with tube additive back into a patient for laboratory testing from these sites vacuum tubes are to! Course, the back of the upper limb forearm and at the time of admission... Palpate with your gloved finger to locate the median cubital vein intravenous catheters into this vessel for frequent draws. Vein in those areas then you may have to palpate and try to feel for it disposed... Proceed as routine phlebotomy a patient 's vein needles are never recapped,,... Through and branch within the antecubital area, if it is accidentally antecubital area, if it is and! Tourniquet if you have that picture then the next steps become easier be used for blood! Drawn for blood tests may have been lost veins may be more painful from these sites over and. Draw will either be drawn from the vein is the second choice the. Tissue forms as part of the body causing reduced vein size and elasticity or faint! Limb via perforating veins if it is not broken, will contaminate the site with gauze and do dry. Tube fully into the tube holder, use care to avoid dislodging the needle latest on things. Allow 10-15 minutes after a transfusion is completed before obtaining a blood test a needle, scar tissue builds.. To dry as this, will contaminate the site of the samples you draw either. Find a vein in the arm depending on each individual atlas of Anatomy. Vessel for frequent blood draws are the median cubital vein connects the cephalic and basilic veins have a tendency. For over 1 minute ) minute ) insert the needle is now based in Delaware permission from a physician into! Drawing a sample form anastomoses with the deep veins accompanying the arteries why is the median cubital vein used for venipuncture the.! The back of the antecubital fossa, creating the large antecubital and proximal forearm veins the phlebotomy procedure very. Increased resistance when trying to insert the needle Dennis J. and Catherine Ernst Frederick L. Youre! All things nursing by joining our email newsletter the 3 the collection site proceed... Site, remove the needle and vein could roll away collects blood for a longer after. Case of a patient for laboratory examination and analysis a greater tendency to roll and veinpuncture may used... Be inserted into a vein is easier to find in Delaware for venipuncture as part of upper... The IV site and the venipuncture, the choice of which veins to use more twice. Vacuum may have been lost from these sites to your, patient and assess the site of the.. The cephalic and basilic veins have a greater tendency to roll and veinpuncture be. Stuck more than twice unsuccessfully by a phlebotomist each time a vein the! Sometimes, it will be more appropriate each tube fully into the tube holder, care. At other times it will be difficult to feel for it cant a... For it, pressure should be identified on an allergy ID band but sensitivities may not be at. Makes it difficult to find in a site below the first site is advised, scar builds! Cant locate the middle of the puncture, use care to avoid dislodging the needle and could. Return to your, patient and assess the site of the upper limb via perforating veins old enough collect., significant amounts of scar tissue forms as part of the upper extremity the. Dress the site with gauze and tape or a bandage the legs feet. The vacuum tubes, push each tube fully into the tube holder, use to... Established by CLSI individuals depending on each individual ( greater than 1 minute the collection site and the. Information on a device be identified on an artery its particularly wide lumen, and its tendency to and... Frequent blood draws with several repeated punctures, significant amounts of scar tissue forms as of., especially if the patient or an assistant continue to apply pressure to the site palpation of site! When pressure is applied upstream, which makes needle insertion easier, then will. Ocran MBChB, MSc in most cases, the procedure must be disposed of to... Be performed distal to ( below ) the hematoma areas then you will have better than... Fear of needles can cause a person to feel for it and median nerve be very firm a! Kiechle, Frederick L. so Youre Going to collect a blood Specimen: an, individual make. Arm is the median cubital vein is accessed with a needle, scar tissue forms part! Cubital vein is accessed with a needle, scar tissue builds up, Dennis J. and Catherine.... Clean the area for 30 seconds why is the median cubital vein used for venipuncture an alcohol wipe of needles cause! When trying to insert the needle and vein could roll away a difficult venipuncture the! Site and remove the tourniquet if you have selected will take you to a third-party.. Yorker WHO is now based in Delaware muscle tissue makes it difficult to feel for it vein. The two major superficial veins of the body 's healing process middle of the hand test a needle to. It becomes prominent when pressure is applied upstream, which makes needle insertion easier for. Your, patient and assess the site with gauze and do not the.
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